Provider Demographics
NPI:1255192589
Name:BARAJAS, CASSIE MARIE
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MARIE
Last Name:BARAJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 RUSHING CURRENT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2513
Mailing Address - Country:US
Mailing Address - Phone:805-540-8130
Mailing Address - Fax:
Practice Address - Street 1:7557 RUSHING CURRENT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2513
Practice Address - Country:US
Practice Address - Phone:805-540-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIN05597390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program